Constantine Cannon Settles Whistleblower Case with Sharp Healthcare Center for Research
A whistleblower represented by Constantine Cannon, who exposed an alleged cycle of deceit at Sharp HealthCare, a regional hospital system in San Diego, has settled a False Claims Act lawsuit against the Sharp Healthcare Center for Research, Sharp’s clinical-trial research arm.
The whistleblower suit alleged that Sharp fraudulently billed government payers, like Medicare and Medicaid (known as Medi-Cal in...
A home health agency that allegedly defrauded Medicare and Louisiana’s Medicaid program has agreed to pay $2.5 million to settle claims arising from a qui tam suit. Defendants Health Care Options, Inc., Health Care Options of Lafayette, Inc., Home Care Options Houston, Inc., and Howard Austin, II allegedly submitted reimbursement claims involving non-face-to-face encounters, as required by program rules. USAO MDLA
Appellate Decision Raises Questions for Relators Seeking a Share from Alternate Remedies
The Third Circuit caught industry headlines when it was reported to have ruled on October 28, 2019, that a whistleblower had no right to an award based on a portion of criminal fines or forfeitures. That would upend longstanding rights of relators to share in the proceeds of “related proceedings.”
Thankfully, the real scope of the opinion is less far-reaching, though it would be wise for relators to consider...
A New York-based painting contractor has agreed to pay $3 million to settle a suit alleging it misrepresented compliance with Disadvantaged Business Enterprise (DBE) rules in connection with two federally funded construction projects. The False Claims Act violations involved Ahern Painting Contractors Co., which was contractually required to hire DBE subcontractors to perform renovation work on the Brooklyn Bridge and Queens Plaza. However, Ahern hired a non-DBE, Spectrum Painting Corp., and repeatedly submitted false statements to the government that represented the work was done by a real DBE, Tower Maintenance Corp. USAO SDNY
CATCH OF THE WEEK — Sanford Health to pay over $20M for kickback, unnecessary spinal surgery claims brought by two Sanford doctors
Our Catch of the Week features a $20.25 million settlement with South Dakota-based Sanford Health, Sanford Medical Center, and Sanford Clinic announced by the Justice Department in an October 28, 2019 press release. The settlement resolves allegations the massive health system knowingly submitted claims for medically unnecessary spinal surgeries and tainted by kickbacks to a top Sanford neurosurgeon. Two Sanford...
Encompass Health Corporation (EHC), f/k/a HealthSouth Corporation, has agreed to pay $4 million to resolve of improperly billing Medicare. According to the DOJ, between 2008 and 2012, an inpatient rehabilitation facility owned by EHC had improperly assigned low Functional Independence Measure scores on Patient Assessment Instrument forms in a bid to receive higher reimbursements from Medicare. USAO NV
Sanford Health, Sanford Medical Center, and Sanford Clinic have agreed to pay $20.25 million and enter into a Corporate Integrity Agreement in order to resolve alleged violations of the Anti-Kickback Statute and False Claims Act. Despite warnings by several physicians that a top neurosurgeon was illegally profiting off his use of implantable medical devices as well as performing medically unnecessary surgeries involving the devices, Sanford did nothing to stop the offender, allowing Medicare and Medicaid to continue being defrauded. The allegations were raised by Sanford surgeons Drs. Carl Dustin Bechtold and Bryan Wellman, who will share in a $3.4 million cut of the settlement proceeds. DOJ; USAO SD
Two foundations that provide pharmaceutical co-payment assistance to patients have reached agreements to resolve claims that they failed to operate independently of their pharmaceutical company donors and violated or caused the violation of the False Claims Act and Anti-Kickback Statute by working with those companies to ensure that donations received from them would be used to cover co-payments for the donor's drugs, inducing patients to purchase the drugs. The Chronic Disease Fund, Inc. will pay $2 million, and the Patient Access Network Foundation will pay $4 million, amounts that were arrived at based on the entities' abilities to pay. CDF was alleged to have conspired with Novartis, Dendreon, Astellas, Onyx, and Questcor. PANF was alleged to have conspired with Bayer, Astellas, Dendreon, and Amgen. The foundations also entered into 3-year corporate integrity agreements. USAO MA
CATCH OF THE WEEK – Osteo Relief Institutes, Pedaling Dubious Treatment for Arthritis, Tagged for Charging Medicare for Medically Unnecessary Services
On October 18, 2019, the Department of Justice announced a settlement with arthritis treatment provider Osteo Relief Institutes and seven of its locations in Phoenix, Arizona; San Diego, California; Lexington, Kentucky; Wall Township, New Jersey; Dallas, Texas; San Antonio, Texas; and, Colorado Springs, Colorado. According to the DOJ press release, the ORI entities, together with their principals, will collectively...
Following a government analysis of Medicare claims data and a whistleblower's qui tam lawsuit, seven former Osteo Relief Institutes and their owners have agreed to pay more than $7.1 million to settle claims of defrauding Medicare. The alleged fraud involved clinics in Arizona, California, Kentucky, New Jersey, and Texas billing Medicare for medically unnecessary treatments for osteoarthritis, including viscosupplementation injections and knee braces. The whistleblower involved will receive $857,550. DOJ